Peritoneal Dialysis (PD): type of dialysis that uses peritoneal semipermeable membrane to remove excessive wastes and fluids from the blood in peritoneal vessels to a dialysate solution that implant into peritoneal cavity than drain it outside the body.

1. Medical Surgical Nursing
PERITONEAL DIALYSIS
‫الصحة‬ ‫معهد‬
‫العالي‬
‫المادة‬ ‫مدرس‬
‫م‬
.
‫إختصاص‬ ‫جامعي‬
‫الوهاب‬ ‫عبد‬ ‫نزار‬ ‫صـالح‬
‫تمـريض‬ ‫علــوم‬ ‫ماجـستير‬
Salah Nazar Abdulwahhab M.Sc. Nursing
www.slideshare.net
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2. Peritoneal Dialysis
Peritoneal Dialysis (PD): type of dialysis that uses peritoneal semipermeable membrane to remove
excessive wastes and fluids from the blood in peritoneal vessels to a dialysate solution that implant into
peritoneal cavity than drain it outside the body.
Dialysate Solution: the liquid material that passes through the peritoneal membrane in dialysis process
Main Types of Peritoneal Dialysis
1. Continuous Ambulatory Peritoneal Dialysis (CAPD)
Dialysis by a nurse, patient or family
2. Automated Peritoneal Dialysis (APD)
By using computerized machine called a cycler to regulate the exchanges
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3. Peritoneal Dialysis Process
1. Sterile technique during instilling catheter and exchanges process
2. Peritoneal catheter is placed into the patient’s peritoneal space below the waistline near the navel
3. The exchange process has three steps
a. Filling
b. Dwell time
c. Draining
4. The filling step involves instilling a bag of (dialysate) into the patient’s peritoneal cavity through the
catheter by surgical intervention
5. The amount of solution is usually (1500 to 2000) mL.
6. Raising the plastic bag to shoulder level, gravity pulls the fluid into the abdomen. When empty, the
plastic bag is removed and thrown away
7. In dwelling step the cleansing fluid (dialysate) stays inside the abdomen for several hours
8. The waste products and extra fluid move out from the blood through membrane to the dialysate
9. In draining step the dialysate is drained from the abdomen through the PD catheter into a plastic bag
10. The process of these 3 steps (filling, dwelling and draining) is called [exchange]
11. Usually three exchanges are done during the day and one before bedtime
12. Sometimes medications are added to the dialyzing solutions such as
- Heparin to prevent clotting of the catheter
- Insulin for the patient with diabetes
- Antibiotics if there is infection
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4. Peritoneal Dialysis
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5. Advantages of peritoneal dialysis
1. lifestyle flexibility and independence
These can be especially important if you work, travel or
live far from a hemodialysis center.
2. More flexible dietary guidelines.
Peritoneal dialysis is done more continuously
(3-4 times day) than hemodialysis (2-3 times week),
resulting in less accumulation of potassium, sodium and
fluid.
3. More stable blood chemistry and body hydration
Peritoneal dialysis doesn't require intravenous (IV)
access, that lead to change in circulation and fluid levels.
4. Longer residual kidney function.
might retain to kidney function slightly longer than
people who use hemodialysis.
5. Easy for the client and family to learn
6. Better tolerable for patient with heart disease
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6. Complications of Peritoneal Dialysis
Complications of peritoneal dialysis can include:
1. Infections
peritonitis: infection of the peritoneum which can be life threatening
it is a common complication of peritoneal dialysis.
2. Weight gain
The dialysate contains sugar (dextrose) lead to absorbing several
hundred extra calories a day
The extra calories can also cause hyperglycemia, especially in
diabetes
3. Hernia
Holding fluid in the abdomen for long periods may strain the
muscles.
5. Poor fluids exchange
6. Inadequate dialysis
PD can become ineffective after several years, this need to switch to
hemodialysis
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7. Nursing Care for Patient with PD
1. Provide O2 supply for patient with shortness of breath (SOB)
2. Provide clean and quiet environment
3. Provide Comfort by:
a. Put the patient with comfortable position
b. Comfortable bed and pillows
c. Ensure TV and audio is working properly
4. Monitoring of vital signs, especially blood pressure if dropping
too quickly, exchange for a period of time than give (200-300) mL
of normal saline (NS) to balance fluid levels as prescribed
5. Draining starts slowly
6. Modification of dialysis according to the patient's condition and
laboratory analysis
7. Regular Assessment for access site
8. follow up charting for input and output dialysate solution
9. Prevent hard physical activity
10. Follow up diet for patients with renal failure
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8. Thank You
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